Income, Age Linked to Breast Cancer Care Delays in Women 40 and Under

Among women diagnosed with breast cancer at age 40 or younger, lower annual income was associated with higher odds of waiting 90 days or more to see a clinician after first noticing symptoms, and younger age was associated with higher odds of a 90-day or longer interval between that first visit and diagnosis, according to an analysis of the Young Women's Breast Cancer Study published in Cancer.¹

Delays were not associated with disease-free survival (DFS) or overall survival (OS), but presentation delays were associated with later-stage disease in HER2-positive luminal B tumors, which the investigators noted can mean more extensive treatment and quality-of-life effects.^1,2

How was the Young Women's Breast Cancer Study analysis designed?

The analysis included women aged 40 years or younger at diagnosis of stage 0 to IV breast cancer who enrolled between 2006 and 2016 in the Young Women's Breast Cancer Study, a multisite prospective cohort.^1,3 A total of 1,071 women were included.¹

Investigators examined 3 intervals in the care pathway:

• Presentation delay: 90 days or more from the first patient-reported symptom to a clinician visit
• Diagnostic delay: 90 days or more from the first health care visit for symptoms to biopsy-confirmed diagnosis
• Treatment delay: 60 days or more from diagnosis to first treatment^1,2

Multivariable logistic models for each delay were built through backward selection, retaining factors with P ≤ .05. Multivariable Cox proportional hazards models tested associations between delays and DFS and OS, and analyses were stratified by tumor subtype and stage.¹ The data were previously presented in part at the 2025 San Antonio Breast Cancer Symposium (SABCS).¹

How common were care delays among young women?

Across the cohort, investigators identified 153 presentation delays, 120 diagnostic delays, and 228 treatment delays.¹

In the SABCS presentation, median time from first symptom to presentation was 14 days (IQR, 2-45), median time from presentation to diagnosis was 14 days (IQR, 7-30), and median time from diagnosis to treatment was 41 days (IQR, 25-57).⁴

Which patients were more likely to experience delays?

Patient and tumor factors associated with each delay in multivariable models included:¹

• Presentation delay: Lower annual income was associated with higher odds; pregnancy at diagnosis, family history of breast cancer, and triple-negative (TN) subtype were associated with lower odds.
• Diagnostic delay: Odds were higher for younger patients and lower for those with TN tumors.
• Treatment delay: Patients with more aggressive tumor subtypes were less likely to have treatment delays.

Did delays affect stage at diagnosis or survival?

In HER2-positive luminal B tumors, presentation delays were associated with later stage at diagnosis (P < .001).¹ According to a news release, women who experienced a diagnostic delay were also more likely to have late-stage disease.²

Delays were not associated with DFS or OS.¹ "It is reassuring that delays did not influence disease outcomes," the investigators wrote.¹ However, the release noted that a later-stage diagnosis may require more extensive surgery, radiation, or systemic therapy, which can affect quality of life and other outcomes.²

"Our study reveals continued issues in care delay among patients with young-onset breast cancer and emphasizes a need to improve both patient and provider understanding of young-onset breast cancer risk factors and symptoms to decrease disease burden among these patients," senior author Kristen D. Brantley, PhD, MPH, of Dana-Farber Cancer Institute, said in the release.²

Why are young women vulnerable to delays in breast cancer care?

Breast cancer diagnosed before age 40 falls below the recommended screening age, and younger women may be less likely to be screened and may face delays because their symptoms are not initially suspected to be cancer, according to the release.² An earlier analysis from the same cohort, published in Cancer in 2014, also examined presentation and diagnostic delays in young women.⁵

Time pressure shapes other decisions for this population. In a qualitative study recently covered by Oncology Nursing News, young women with breast cancer described making fertility preservation choices while absorbing a new diagnosis and trying to begin treatment promptly.⁶ Navigation models are also being tested for adolescents and young adults with cancer who face financial hardship or unmet health-related social needs; an interim fidelity analysis of the randomized AYA-NAV trial found that the intervention was largely delivered as designed.⁷

What are the study's limitations?

The cohort enrolled patients between 2006 and 2016, and the intervals were anchored to the first patient-reported symptom.^1,2 Effect sizes for individual risk factors were not available in the published abstract. Several authors reported advisory roles, honoraria, consulting fees, travel grants, or grant funding from pharmaceutical companies; funding for the analysis was not described in the abstract or release.^1,2

What are the key takeaways for oncology nurses?

• Take new breast symptoms seriously at any age. Diagnostic delays were more likely among the youngest patients, and the senior author called for better provider understanding of young-onset risk factors and symptoms.^1,2 Nurses and physician assistants in primary care, women's health, and triage roles can help move a patient under 40 with a new breast change to timely imaging and biopsy.
• Screen for financial barriers early. Lower annual income was associated with higher odds of presentation delay.¹ Asking about cost, insurance, transportation, and time off work at intake, and connecting patients with social work or financial navigation, may help close that gap.
• Educate young patients about symptoms. Pregnancy at diagnosis and family history were associated with lower odds of presentation delay, suggesting that contact with the health system and awareness of risk may prompt earlier care.¹ Teaching young women which breast changes warrant prompt evaluation supports earlier presentation.
• Track the clock from diagnosis to treatment. The study used 60 days from diagnosis to first treatment as its threshold for treatment delay.¹ Navigators and clinic nurses can monitor this interval and flag patients whose consults, fertility referrals, or insurance approvals are stalling.⁶
• Watch the HER2-positive luminal B subgroup. In these tumors, presentation delay was associated with later stage (P < .001), which can mean more extensive treatment.^1,2
• Counsel with accurate context. Patients who delayed care may worry they harmed their prognosis. In this cohort, delays were not associated with DFS or OS, while later-stage diagnosis was linked to more extensive treatment and potential quality-of-life effects.^1,2

References

1. Zhang BX, Sella T, Zheng Y, et al. Delays in breast cancer presentation, diagnosis, and treatment in young women. Cancer. 2026;132(20):e70594. doi:10.1002/cncr.70594

2. Are young women receiving delayed care for breast cancer? News release. Wiley. October 12, 2026. Accessed November 9, 2026. https://newsroom.wiley.com/press-releases/press-release-details/2026/Are-young-women-receiving-delayed-care-for-breast-cancer/default.aspx

3. Rosenberg SM, Zheng Y, Ruddy K, et al. Helping ourselves, helping others: the Young Women's Breast Cancer Study (YWS)—a multisite prospective cohort study to advance the understanding of breast cancer diagnosed in women aged 40 years and younger. BMJ Open. 2024;14(6):e081157. doi:10.1136/bmjopen-2023-081157

4. Zhang BX, Sella T, Zheng Y, et al. Delays in breast cancer diagnosis and treatment in young women. Presented at: San Antonio Breast Cancer Symposium; December 9-12, 2025; San Antonio, TX. Abstract PS3-02-16. Clin Cancer Res. 2026;32(4 suppl):PS3-02-16.

5. Ruddy KJ, Gelber S, Tamimi RM, et al. Breast cancer presentation and diagnostic delays in young women. Cancer. 2014;120(1):20-25. doi:10.1002/cncr.28287

6. For young women with cancer, fertility choices evolve beyond diagnosis. Oncology Nursing News. November 6, 2026. Accessed November 9, 2026. https://www.oncnursingnews.com/view/for-young-women-with-cancer-fertility-choices-evolve-beyond-diagnosis

7. AYA needs navigation trial meets most fidelity targets at interim look. Oncology Nursing News. November 3, 2026. Accessed November 9, 2026. https://www.oncnursingnews.com/view/aya-needs-navigation-trial-meets-most-fidelity-targets-at-interim-look